Table_4_Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study.DOCX

Background: Few studies examined the effects of combined motor and cognitive rehabilitation in patients with multiple sclerosis (MS). The present prospective, multicenter, observational study aimed to determine the efficacy of an integrated cognitive and neuromotor rehabilitation program versus a traditional neuromotor training on walking, balance, cognition and emotional functioning in MS patients.
Methods: Sixty three MS patients were selected and assigned either to the Integrated Treatment Group (ITG; n = 32), receiving neuropsychological treatment (performed by ERICA software and paper–pencil tasks) complemented by conventional neuromotor rehabilitation, or to the Motor Treatment Group (n = 31) receiving neuromotor rehabilitation only. The intervention included two 60-min sessions per week for 24 weeks. At baseline and at end of the training all patients underwent a wide-range neuropsychological, psychological/emotional, and motor assessment.
Results: At baseline the two groups did not differ for demographic, neuropsychological, psychological/emotional, and motor features significantly. After rehabilitation, only ITG group significantly (p-corrected for False Discovery Rate) improved on test tapping spatial memory, attention and cognitive flexibility, as well as on scales assessing depression and motor performance (balance and gait). A regression analysis showed that neuropsychological and motor improvement was not related to improvements in fatigue and depression.
Conclusion: The present study demonstrated positive effects in emotional, motor, and cognitive aspects in MS patients who received an integrated cognitive and neuromotor training. Overall, results are supportive of interventions combining motor and cognitive training for MS.

背景：鲜有研究针对多发性硬化（multiple sclerosis, MS）患者接受运动与认知联合康复的疗效展开探讨。本项前瞻性多中心观察性研究旨在对比整合式认知与神经运动康复方案与传统神经运动训练，对多发性硬化患者步行能力、平衡能力、认知功能及情绪状态的改善效果。
方法：共纳入63例多发性硬化患者，随机分配至整合治疗组（Integrated Treatment Group, ITG；n=32）与运动治疗组（n=31）。整合治疗组接受由ERICA软件及纸笔任务构成的神经心理治疗，并辅以常规神经运动康复；运动治疗组仅接受神经运动康复。本次干预共持续24周，每周开展2次训练，每次时长60分钟。分别于基线及训练结束时，对所有受试者实施全面的神经心理、心理/情绪及运动功能评估。
结果：基线阶段，两组在人口学特征、神经心理指标、心理/情绪状态及运动功能方面均无显著统计学差异。康复干预结束后，仅整合治疗组在空间记忆、注意力与认知灵活性相关测试，以及评估抑郁症状与运动功能（平衡与步态）的量表中取得了显著改善（经错误发现率（False Discovery Rate）校正后的p值）。回归分析结果显示，神经心理与运动功能的改善与疲劳及抑郁症状的改善并无相关性。
结论：本研究证实，接受整合式认知与神经运动训练的多发性硬化患者，在情绪、运动及认知功能层面均获得了积极改善。总体而言，本研究结果支持针对多发性硬化患者采用运动与认知训练相结合的干预方案。